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PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland
COUNTY, PENNSYL VANIA
Estate of Ray Wilmer Elliott
also known as Ray W. Elliott
File Number
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. Deceased
Social Security Number 192-14-7207
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
IZJ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is I are the Executors
last Will of the Decedent dated August 27,1997 and codicil(s) dated None
named in the
(State relevant circumstances, e.g., renunciation, death of executor, etc.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instrument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: None
o B. Grant of Letters of Administration
(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has I have ascertained that Decedent left no Will and was survived by the following spouse (if any) 3fld>heirs: (If
Administration, c.t.a. or d.b.n.c.t.a., enter date o/Will in Section A above and complete list o/heirs.) Q g;
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Name
Relationship
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(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his I her last principal residence at
210 Big Spring Road. Newville. West Pennsboro Township. Cumberland County. Pennsylvania 17257
(List street address, town/city, township, county, state, zip code)
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Decedent, then 87 years of age, died on December 31,2007
Cumberland County. Pennsylvania
at Green Ridge Village, West Pennsboro Township,
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(Ifnot domiciled in PA) Personal property in Pennsylvania
(If not domiciled in P A) Personal property in County
Value of real estate in Pennsylvania
2,500.00
$
$
$
$
123,000.00
'tu t d fi II Newville Road, Southampton Township, Cumberland County
SI a e as 0 ows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
T ed or rinted name and residence
Larry Elliott 179 Chamberlin Road, Shippensburg, Pa. 17257
Ronald Elliott 1548 Orrstown Road, Shippensburg, Pa. 17257
Gloria Wrights 2 Willow Lane, Shippensburg, Pa. 17257
Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF Cumberland
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of
the knowledge and belief ofPetitioner{s) and that, as personal representative{s) ofthe Decedent, Petitioner(s) will well and truly
administer the estate according to law.
before me the
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day of
~A~ ['~/;j:N-
gnatu of Personal Representative
~at:
Sworn to or affirmed and subscribed
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Estate of Ray Wilmer Elliott
. Deceased
Social Security Number: 192-14-7207 pate of Death: December 31,2007
AND NOW. ~ do. . aOli . in oooside<ation of the fo,egoing Petitioo, ",ti,fuctmy proof
having been presented be re me, IT IS bE CREED that Letters Testamentary
are hereby granted to Larry Elliott, Ronald Elliott and Gloria Wrights
in the above estate
and that the instrument{s) dated August 27,1997
described in the Petition be admitted to probate and filed of record as the last
FEES
Letters .,. ia ~,.Ql?9 . . $
Short Certificate(s) . .3. . .. $
Renunc~~f~s) .......::: ~
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Attorney Signature:
... $
... $
... $
... $
... $
... $
... $
... $
TOTAL . . .. . . . . . . . . .. $
IS
to
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Attorney Name:
H. Anthony Adams
Supreme Court I.D. No.: 25502
Address:
49 West Orange Street
Suite 3
Shippensburg,Pa.17257
Telephone:
717-532-3270
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Form RW-02 rev, 10,13.06
Page 2 of2
H105.805 REV (Ol/07)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 14007387
Certification Number
-,-_._--_..---~...,-_...__.~--~---..-._._.._----_._--....- .. .~~~-----
This is to certify that the information here given is
correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
celtificate will be forwarded to the State Vital
Records Office for perma ing.
H105-143 REV 1112006
TYPE I PAINT IN
PE~ENT
BlACK INK
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
VIS.
ea. Place 01 Death (Ched< on~ one)
Ho$plla"
o ~nt 0 ER 1 Outpatient 0 DOA ~ Nu~ng Home 0 Res""",,
9. W.. _ 01 "...nic Origin? lXI No 0 Yes
("",s._C_.
Green Ridge Village Uex;can.Puerto RJcan,.to)
12. Was Oecedsm ever in the 13, [)ecedenl's Educalion (Sp8Cify only higheSt grade completed) 14, Marital Salus: Married, Never Mttrried.
U.S. Armed Fon:es1 Elomenla"ll _"111>1') College ('''\ 01 &+) Widowed, OMl!ced (Sjl<Ci/y\
KJv" ONo 8 years widowed
,. Nome 01 Dec:ellenl (First, _, lesI,sulIx)
Ray W. Elliott
5. Age (Last Birthdey) Under 1 r
......
6. Date of Birth (Month. dey. ",,,)
7. 1lir1hplece (C.
7-10-20 Shippensburg, PA
6d. Facilly NMneI"'" inst....., g\v<l_ end_)
87
6b. County 01 Oesth
Cumberland
pennsboro Twp.
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11. Decedent', Usual llon Kind most of lie. Do not &tale retired
Krd 01 wort< Kind 01_1 InduslIy
Dairy Farmer Self Employed
. 16. Decedent's MUng AddreSs (Street, city I town, state, zip code)
210 Big Spring Road
Newville, PA 17241
18. Father', Name (First, mQdIe, Iul. suffIx)
Thomas P. Elliott
PA
Cumberland
_'s
ActuaJ Resil:Ieooe 17a, State
17b. County
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10. Race: American Indian, Black, Whrte, etc.
(5pedfyj
White
~~nl 17e.~v",~nlUvedin West Pennsboro Twp.
Townsh~? 17d.D No. _ Uved_
AcluelUmilsol
Top.
ClyIBoro
19. Mohr's Name (f\fS1" midtIe, maiden 8l11NlRl9)
Mary Belle Kyle
201>. ~fonnenl's Ma.mgAddress (Street. city ,_, _. ztp code)
179 Chamberlin Road, Shippensburg, PA 17257
21e. Place 01 Disposition (Name 01_. "emaloIy 01 od"" plece) 'ld.lDca1ion (Cly/_....e.z~code)
1lems24.261l1lSl"CClOI'llletedbypelSOll
. who~dea\h.
CAUSE OF DEATH (See Instructions 8nd examples)
l\em27. Pan l; Enlerlhe ~ - dseases,....., or COl'l'lpbcaIlon -lhat direcIIy QWS8d the death. DO NOT enlerterminal evenls such as cardiac arresl,
mspiratory arresl, 01 venllicular fbrHIalion without shoWing the etiology. list only one cause on each line.
==~~,\~ "",o.hs:.s
· Ouelo(or..~~ol), ~
I Approximate Interval:
I Onsel to Death
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==t~'~a:a.
EnleIIhe UNDERLVING CAUSE
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b.
Due \0 lor 8B a oon58qU9nte of):
e.
Due \0 {or as a consequeoce ol):
d.
31. Manner 01 !loalh
3Ob. Were Autopsy FixIngs
Avalla.ble Prior 10 CompIelion
01 Cause 01 O8a1h?
3)&, Was an Autopsy
Pe<1oomed?
~el 0__
O_OPenlinglfO'l8S1jgelion
o Suicida 0 Could No! be IlO1ennlned
M.
Shippensburg, PA 17257
F.R. Inc., Shippensburg, PA 17257
23<. Oal. Signed (Month, dey, ",,,)
1:),,-3/- 0
Part II: Enler other sionificanl mnditioru: contributina to dlIatl\.
bulnol resuIIingilthe underlying cause gfYen In Part I.
321.IITrenspor1ationlnju~(SpecIty)
ODriYerlOpelelor OP
Other - Speci~'
338. Certifier (check only one) 33b. Signature a
=1~:"~~,n~~=~~~u=~=M~~_~~h~~~~~~e::3~_________________ Er ~
pronouncing and certifying phy&Ician (Physician both pronouncing death and cer1ifying 10 cause of death) 33c. License
Tothebef1m l'rtf know\edge,deathoct:Ufft!da1.thetlme, da1e,lI"ldplate,andduetotheC8US4!(8)8ndmannerasslatecL -.. - - --- - - - -.. ---- - 0 00
Medical Examiner' Coronet I
On the basis of etamlnetlon and
DYes 13";"
oy" ONo
32d. Tme 01 Injury
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26. Did Tabaooo Use Ccn\JWe to Death?
DYes DP-
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29. n Female:
o NoIpregnan\wilhinpaslyeBr
o Pregnenl" tine 01 dee1h
o No!",egnant,,,",pregnenlwilhin42deys
of death
o Not pregnant. bvl pregnanl.-3 dayS 10 1 year
before death
o _'pregnenlwlhin'l1epes\yaar
32c. ==~:.7~j Streel, Faclory,
p.o.
33d, Date Signed (Month, day, year\
1</31/01'
th curret! at the time, dale, and plece.8nd due to the cause(a) and manner 8f. staled- 0
34. ~~~\SolP~~~t~seol:~~"~m27) TYll9fPmt
1."1 / :z /.5- 36.o.teFiOd(Monfu.dav.'("'rI 7 51;, A.,.\"""., ~~
. r\.-. I I I I tlO c...,...\~I... ff>-.. \ '-'015
35. Registrar's $islOClture and Dist
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00 11 b \ 3 t"\
Disposition Permit No,
LAST WILL AND TESTAMENT
KNOW ALL MEN BY THESE PRESENTS, that I, RAY WILMER ELLIOTT,
of Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this my Last will and
Testament, hereby revoking all prior wills and codicils by me at
any time heretofore made.
FIRST: I direct the payment of all my legal debts, funeral
expenses including my grave marker and all expenses of my last
illness, state, federal estate and inheritance taxes,
administration costs, etc., shall be paid from my residuary
estate and shall not be charged or apportioned to any other
(-)
legatee, donee, beneficiary or joining tenant as soon as~~ be
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conveniently done following my decease leaving all specific'
bequests free of tax to the legatee.
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SECOND: I give, devise and bequeath all my property ~e it~"
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real, mixed or personal, wherever situate in four equal shares ~
with one share going to each of my children namely, Larry
Elliott, Ronald Elliott, Gloria Wrights, per stirpes, and the
remaining share being divided equally between the spouse and
children of my son, Richard Elliott who is deceased. The said
spouse and children Suzie Elliott, Carol Elliott, Mary Elliott,
Thomas Elliott and Jennifer Elliott to share equally, per
stirpes.
THIRD: I nominate and appoint Larry Elliott, Ronald Elliott
and Gloria Wrights, as the Executors of this my Last Will and
Testament.
IN WITNESS WHEREOF, I, RAY WILMER ELLIOTT, to this my Last
will and Testament, set my hand and official seal, this d 7~
day of August, 1997.
It. ? ~ ij(!A-~~
u~ ~t/"L ,~rt" (SEAL'>1
Ray . mer Elliott '
Sworn to and subscribed, declared and
published by Ray Wilmer Elliott, as
his Last Will and Testament, and so
done in the presence of we the
witnesses, who sign at his request/"
and in his presence, and in the
presence of each other.
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COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND
I, Ray Wilmer Elliott, whose name is signed to the foregoing
instrument, having been duly qualified according to law, do
hereby acknowledge that I signed it willingly; and that I signed
it as my free and voluntary act for the purpose therein
expressed.
J&-j~ ~.fJfJ ~~-41
Ray Wilmer Elliott
Sworn to and acknowledged, before me,
by Ray Wilmer Elliott, the Testator,
t 's ~~ day of August, 1997.
NOfARIAL SEAL
DAWN MARIE SHOOP. NOTARY PUBLIC
Shippen.... Cumbertand County. PA
My eommiaion bt*es February 5. 2000
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND
WE, H. Anthony Adams and Sharon Coleman Adams, the
witnesses whose names are signed to the foregoing instrument,
being duly qualified according to law, do depose and say that we
saw the Testator sign and execute the instrument as his Last will
and Testament; that he signed willingly and that he executed it
as his free and voluntary act for the purposes therein expressed;
that each of us in the hearing and sight of the Testator signed
the will as witnesses, and that to the best of our knowledge and
the Testator was at the time at least eighteen (18) or more years
of age and of sound mind and under no constraint or undue
influence.
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Sworn to and subscribed before me by,
H. Anthony Adams and S ron Coleman Adams,
t e\ witnesses, this day of August, 1997.
DA NOI'ARfAl SEAL
Sh~ MARIE SHOOP, NOTARY PUBUC
M Ippen~. Cumberland County, PA
y CommIssIOn Expires February 5, 2000